Free
Research Article  |   January 2010
Geriatric Research
Author Affiliations
  • Susan L. Murphy, ScD, OTR/L, is Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Michigan, 300 North Ingalls Street, 9th Floor, Ann Arbor, MI 48109-2007, and Research Health Science Specialist, Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI; sumurphy@umich.edu
Article Information
Centennial Vision / Geriatrics/Productive Aging / Centennial Vision
Research Article   |   January 2010
Geriatric Research
American Journal of Occupational Therapy, January/February 2010, Vol. 64, 172-181. doi:10.5014/ajot.64.1.172
American Journal of Occupational Therapy, January/February 2010, Vol. 64, 172-181. doi:10.5014/ajot.64.1.172
Abstract

The American Occupational Therapy Association’s Centennial Vision articulates the need for occupational therapy to be science driven and evidence based in major practice areas. This article provides a review on the state of the occupational therapy research published in the American Journal of Occupational Therapy (AJOT) in the area of productive aging in the past 2 years (2008–2009). The article identifies the types of research published, assesses how well the journal is meeting the Centennial Vision in productive aging research, and discusses implications for utilization of the evidence by occupational therapy practitioners. Although many basic research articles provide a foundation for future intervention development and further define practice roles, the AJOT articles addressing productive aging represent diverse research questions and have produced a body of knowledge that is not easily translated to practice. More effectiveness studies are needed to provide adequate evidence for occupational therapy intervention with older adults.

To commemorate the American Occupational Therapy Association’s (AOTA’s) 100th anniversary, the Board of Directors proposed a Centennial Vision for the profession. The vision states that by the year 2017, occupational therapy will be “a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (AOTA, 2007, p. 613). The Centennial Vision was proposed to establish priorities and benchmarks by which progress can be tracked.
The American Journal of Occupational Therapy (AJOT) supports this vision by publishing research that can build occupational therapy’s evidence base. During the strategic planning for tracking progress of this vision, six main practice areas were identified: (1) productive aging; (2) childhood and youth; (3) rehabilitation, disability, and participation; (4) mental health; (5) work and industry; and (6) health and wellness (Corcoran, 2007). By organizing research into these areas, AJOT can synthesize bodies of literature to track research advancements and facilitate practitioners’ use of evidence.
One practice area in which the need for occupational therapy services will be growing is productive aging. By 2030, estimates are that 72 million Americans, or 1 in every 5 people in the United States, will be ≥65 (Day, 1996). Not only will rehabilitation services be in greater demand, a concerted national effort to promote healthy lifestyles and improve Americans’ quality of life will also exist (U.S. Department of Health and Human Services, 2000). Occupational therapists are uniquely qualified to respond to the needs of older adults across the spectrum of ability. However, although opportunities for occupational therapy are plentiful and growing, our discipline needs to be able to draw on evidence to support reimbursement for services.
The trends in publication of geriatric research are improving. From a review across 5 years of prominent occupational therapy journals, Case-Smith and Powell (2008)  found that articles on geriatric topics increased from 10% to 14% from 2001 through 2005. Within AJOT in 2008, 19% of all research studies fell into the practice area of productive aging (Gutman, 2008). In this article, I review all geriatric research published in AJOT in the past 2 years (2008–2009) to (1) identify the types of research published, (2) assess how well the journal is meeting the Centennial Vision, and (3) discuss implications for practitioners’ use of the evidence.
Types of Research Articles Published
Articles are classified by type: effectiveness study, systematic or narrative review, efficacy study, basic research, instrument development and testing, and the link between occupational engagement and health. Effectiveness studies are defined as studies in which the primary purpose is to examine whether the intervention provides the intended health benefits to participants (Gutman, 2008). Efficacy studies are defined as those that focus on other elements of interventions, such as cost, safety, time efficiency, or patient satisfaction (Gutman, 2008; Sussman, Valente, Rohrbach, Skara, & Pentz, 2006). Basic research is descriptive, providing knowledge about an experience or phenomenon; however, this research does not necessarily translate into guidance for intervention research (Gutman, 2009). For instance, in occupational therapy, a basic research article may focus on risk factors for a particular health problem without providing directions for developing interventions. Articles involving instrument development and testing focus on testing psychometric properties of measures (e.g., reliability and validity). Some research is classified as linking occupational engagement and health. This type of research is considered a research priority in occupational therapy; it can help translate theory into practice and highlight the unique practice areas of occupational therapy to the public (Gutman, 2008).
In 2008 and 2009, AJOT published 14 research articles classified as productive aging articles (Figure 1). Articles pertaining to productive aging involve research that can inform best practices in aging and include an older adult sample. Each article is classified by type in Table 1 and described in detail in Table 2. Of the 14 articles, 1 (7%) examined the effectiveness of an occupational therapy intervention (Yuen, Huang, Burik, & Smith, 2008). No studies were published about clinical efficacy of interventions, such as patient safety, satisfaction, and time and cost efficiency. Four systematic reviews (29%) examined different driving interventions that were conducted as part of AOTA’s Evidence-Based Practice Project (Arbesman & Pellerito, 2008; Bohr, 2008; Hunt & Arbesman, 2008; Stav, 2008).
Figure 1.
Types of productive aging articles published in the American Journal of Occupational Therapy in 2008–2009.
Figure 1.
Types of productive aging articles published in the American Journal of Occupational Therapy in 2008–2009.
×
Table 1.
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence×
Author and YearEffectiveness StudySystematic–Narrative ReviewEfficacy Study Basic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Hunt & Arbesman (2008) XQuantitativeI
Stav (2008) XQuantitativeI
Bohr (2008) XQuantitativeI
Arbesman & Pellerito (2008) XQuantitativeI
Kay, Bundy, & Clemson (2009) XQuantitative
Classen, Awadzi, & Mkanta (2008) XQuantitative
Finlayson, Garcia, & Cho (2008) XQuantitative
Finlayson, Shevil, & Cho (2009) XQuantitative
Haak, Fange, Horstmann, & Iwarsson (2008) XQuantitativeI
Yuen, Huang, Burik, & Smith (2008) XQuantitative
Wood, Womack, & Hooper (2009) XMixed method
Mann et al. (2008) XQuantitative
Murphy, Smith, & Alexander (2008) XQuantitative
Schmid & Rittman (2009) XQualitative
Table 1.
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence×
Author and YearEffectiveness StudySystematic–Narrative ReviewEfficacy Study Basic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Hunt & Arbesman (2008) XQuantitativeI
Stav (2008) XQuantitativeI
Bohr (2008) XQuantitativeI
Arbesman & Pellerito (2008) XQuantitativeI
Kay, Bundy, & Clemson (2009) XQuantitative
Classen, Awadzi, & Mkanta (2008) XQuantitative
Finlayson, Garcia, & Cho (2008) XQuantitative
Finlayson, Shevil, & Cho (2009) XQuantitative
Haak, Fange, Horstmann, & Iwarsson (2008) XQuantitativeI
Yuen, Huang, Burik, & Smith (2008) XQuantitative
Wood, Womack, & Hooper (2009) XMixed method
Mann et al. (2008) XQuantitative
Murphy, Smith, & Alexander (2008) XQuantitative
Schmid & Rittman (2009) XQualitative
×
Table 2.
Productive Aging Articles Published in AJOT in 2008–2009
Productive Aging Articles Published in AJOT in 2008–2009×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion–Exclusion CriteriaInstruments, Measures, and Interventions UsedStatistics UsedResultsStudy Limitations
Hunt & Arbesman (2008) SRISearch terms developed by project coordinator, author of each review, and advisory board. Medical librarian assisted in article search.Literature search: peer-reviewed literature between 1980 and 2004; searching done in online databasesVisual, cognitive, and motor interventions: Visual attention—Useful Field of View Test; oculomotor skills and eye–hand coordination—Dynavision; home exercise programn/aRemediation of visual, cognitive, or motor deficits improves skillsUnclear whether studies that focus on skill remediation are translatable to on-road performance. Effects could reflect learning because the training tool was often also used as the assessment measure.
Inclusion: studies with OT in intervention or within the scope of OT practice and included interventions to the person, including family involvement and role of passengersEducational interventions: driver education, self-awareness–regulation programs, driving simulatorsDriving education programs and effect-of-passengers studies had mixed results.SR limited by heterogeneity in study quality, including lack of randomization, no control groups, small sample size, self-reported outcomes.
19 articles (10 Level I, 6 Level II, 3 Level III)Effect of passengers; medical interventions: cataract surgery, cognition-enhancing drugsMedical interventions showed positive effects on balance, decreased crash rate, and driving performance.
Stav (2008) SRISame as Hunt & Arbesman (2008) Literature search: Same as Hunt & Arbesman (2008) Policy interventions:n/aMore stringent relicensure policies reduced traffic-related fatalities; in Finland, more stringent policies in licensing of older adults may be linked to increased fatalities in this age group using alternative transportation.More inclusive outcome measures needed in policy studies (beyond data on short-term fatalities that may not fully capture crash incidents).
Inclusion: studies with policy interventions related to licensure restrictions, relicensing criteria, and retesting community mobility interventions related to program effectiveness or program evaluationIncreased testing during license renewal (e.g., visual screening, on-road testing), scores on performance tests, restricted or conditional licensingOutcomes do not include effects on participation or quality of life, which are often of most interest for OT intervention.
7 articles (6 Level II, 1 Level III)Community interventions: Alternative transportation programResearch into community mobility is lacking.
Bohr (2008) SRISame as Hunt & Arbesman (2008) Literature search: peer-reviewed literature between 1999 and 2004Legibility and identification of road signs, lane markings, and walking pace at crosswalksn/aInfrastructure studies showed font type, reflective coating, and traffic sign position affect sign visibility and legibility. Age differences in reaction time, identification errors, and eye fixation found during testing. Differences between indoor and outdoor walking paces were found, suggesting the influence of outdoor environmental conditions.Many studies may not generalize to on-road conditions because they were simulated or performed under only clear and dry weather conditions.
Searching done in online databases primarily in human factors and engineering fields
Guidelines for infrastructure before 1999 taken from a Federal Highway Administration handbook
Inclusion: studies that investigated infrastructure modifications of the physical environment on driving ability, performance, or safety
8 articles (6 Level I, 2 Level III)
Arbesman & Pellerito (2008) SRISame as Hunt & Arbesman (2008) Literature search: same as Hunt & Arbesman (2008) Modifications included window tinting, wind-shield angle, reflectance, familiarity with instrument panel.n/aModifications such as window tinting have negative affects on older adults’ driving performance.Lack of randomization, limited applicability to real-world driving in some studies.
Inclusion: Studies that related to impact of automobile-related modification typesAdaptive equipment included ITS (e.g., in-vehicle navigation and visual enhancement systems).Adaptive equipment shows positive effects in performance and satisfaction in use of some ITS.Lack of studies found in the use of low-tech adaptive equipment (cushions, mirrors, grab bars) and crash safety that may be important for OT interventions
22 articles: 7 on modifications for visibility and adaptive equipment (4 Level I, 3 Level II); 15 on ITS (6 Level I, 7 Level II, 2 Level III)
Kay, Bundy, & Clemson (2009) Preliminary validity studyn/aProspective cohort study, recruitment from two driving rehabilitation centers in Sydney, New South Wales, AustraliaInclusion: having a neurological condition and a diagnosis known to be associated with impaired awareness, ≥ age 60, referred for a driving assessmentDriveAware QuestionnaireKappa to measure agreement of level of awareness in ability between off-road and on-road assessment of driving ability.Substantial agreement (κ = .69) exists between rating of awareness of driving ability before and after on-road assessment.Not clear how 60 participants were selected.
N = 60; 72% sample was male; 77% had either mild cognitive impairment or dementia, and others had stroke, Parkinson’s disease, or other diseases.Although therapists during the on-road assessment were initially blinded to the therapist who rated participants in the off-road assessment, blinding could be breeched by the driving evaluator, who had knowledge of the first therapist’s evaluation.
Different therapists conducted on-road assessments; inter-rater reliability between therapists was not reported.
Classen, Awadzi, & Mkanta (2008) Secondary data analysis, cohortn/aU.S. Dept of Transportation 2003 Fatality Analysis Reporting System, a national crash database that contains census data on all crashes on public roads that result in at least one fatality 30 days after the crashInclusion: ≥ age 65 and involved in at least one auto crash in 2003Used theoretical model (Precede Proceed Model of Health Promotion) to identify person, vehicle, and environmental factors related to driving performance.Log-linear modeling to measure two-way interactions among person, vehicle, and environment factorsPerson–environment interactions: Gender differences in when crashes occurredCross-sectional data limit causal inferences.
N = 5,744, 66.6% male, mean age = 75.96, SD = 7.11Vehicle–environment interactions: Crash type varied by time of dayCrashes in dataset were limited to those that involved a fatality. Less serious crashes would also be important to examine for older adults.
Finlayson, Garcia, & Cho (2008) Secondary data analysis, cross-sectional descriptive studyn/aDatabase constructed to examine aging in MS and unmet health-related service needs. It targeted people living in the midwestern United States.Inclusion: ≥ age 45 with a self-reported diagnosis of MSExamined factors associated with use of OT services.Proportional odds models62% of participants had never used OT services as part of their care.OT service patterns in small geographic region may not generalize.
N = 1,282; mean age = 63.8, SD = 9.4; 74% female, mean duration of disease = 20 years, SD = 11.4Most recent users of OT were those residing in an urban or suburban area and those who lived alone. Use of OT was associated with extent of ADL limitations (most recent use associated with highest ADL limitations).OT service use was measured through participant recall.
Finlayson, Shevil, & Cho (2009) Cross-sectional, descriptive studyn/aDataset same as Finlayson, Garcia, & Cho (2008) . N = 1,003; all provided permission to contact their caregivers. Individual caregivers were stratified according to age of participants they cared for who had MS (45–64 or ≥65), and participants were randomly selected to complete an interview.Inclusion: caregiver and participant dyadsAgreement between participants with MS and their caregivers on extent of cognitive symptoms was measured.Kappa and ICC to examine agreement; multi-nomial regression to examine characteristics61 % of participants with MS reported that cognitive symptoms interfered with activity engagement.Questions posed to caregivers and participants with MS about cognitive symptoms not worded identically and relied on self-report.
N = 279 participants with MS (mean age = 62.8, SD = 9.4), mean duration of disease = 18.3 years, SD = 11.8Characteristics of those participants with discrepancies in agreement with care-giver were examined.Fair agreement between caregiver and participants with MS (κ = .39)Gap in time between caregiver interview and participants was several months, during which time cognitive symptoms may have changed.
ICC = .2, (20% of total variation in responses can be attributed to within-pair discrepancies)
Discrepancies in agreement associated with greater disease duration (caregiver noted symptoms more often) and being female (participant noted symptoms more often)
Haak, Fange, Horstmann, & Iwarsson (2008) Secondary data analysis, descriptive study, validity studyn/aENABLE–AGE database of 5 European countries examining home environment and participation in very old people (N = 1,918). Involved baseline interview and follow-up period at 1-year interval (T1 and T2).Sample drawn at random from Swedish Central Population Register and stratified by age and gender.Examined relationship between the housing and neighborhood environments at T1 and two dimensions of participation at T2.Spearman rank correlation coefficientsAspects of housing and neighborhood environment more strongly related to performance-oriented participation and related less strongly to togetherness-oriented participation.1-year gap between environmental factors and participation outcomes may affect relationship.
Inclusion: people ≥ age 80 living alone in 3 Swedish municipalities with sufficient data at T1 and T2Performance oriented and togetherness orientedCriteria for determining sufficient evidence for validity on each dimension are unclear.
N = 314; at T1, median age = 85; 26% were male
median of 2 functional limitations
Yuen, Huang, Burik, & Smith (2008) Randomized controlled trialI5 LTC facilitiesInclusion: resident of LTC facility, ≥ age, spoke English as first language, able to converse for 1 hr, intelligible speech, MMSE score ≥ 19Intervention: Mentoring group—resident mentored an ESL student 2 times a week for 12 weeks with initial orientation by English language teachers.Multi-variate nonparametric global statistic to measure change scores from baseline to post-test and baseline to 3-month follow-upBoth groups had deteriorating well-being over the testing period, but the mentoring group had less deterioration that was statistically significant.Risk of attention bias because usual-care group did not control for attention.
Recruitment by authors meeting with facility staff and with residents of each facilityExclusion: uncorrectable hearing impairments, known maladaptive behavior patterns, psychotic symptoms, and illness with <6 months projected survivalUsual care: No intervention provided.Risk of attrition bias. There was a 28% attrition rate before postintervention data collection, and analysis included data of only participants who completed baseline and follow-up assessments.
ESL students recruited from 3 ESL schools.N = 39, randomized; final N = 28; mean age = 83.4, SD = 8.8; 71.4% female, mean months in LTC = 27.4Instruments used to measure main “well-being” outcomes:Not clear whether statistically significant results translate into clinical meaningful differences.
Geriatric Depression Scale, LSI–A, self-rated healthSmall sample limits generalizability.
Wood, Womack, & Hooper (2009) Case studyn/a2 Alzheimer’s special care units with different social and physical environments selected from centers identified by a local Area Agency on AgingInclusion: diagnosis of Alzheimer’s or neuro-degenerative dementia, ability to walk with or without assistance, ability to communicate needs, resided in SCU for ≥6 monthsActivity in Context and Time, computer-assisted tool to record environmental correlates of time use and affect of people with dementiaMean proportions of time spent in specific activities and affect states calculated.Daily time use and affect suggest that participants had capacities that were infrequently tapped in their activity experiences.Generalization of findings overall, site comparisons, and causal relationships limited because of case study design.
Exclusion: history of or current psychotic illnesses or major depressionStudy involved observation (12 hr per day for 4 days) of each participant by 1 of 4 observers. Codes representing dimensions of time use and affect and considered QoL indicators were recorded by observers.Correlations between specific activities and QoL indicatorsSome site differences found in engagement and affect at the traditional SCU compared with the homelike facility.
Participants at sites matched by age, gender, and functional status
N = 14; mean age = 81 at Site 1; mean age = 83 at Site 2
Mann et al. (2008) Secondary data analysis, longitudinal cohort studyn/aData were from Rehabilitation Engineering Research Center on Aging Consumer Assessments Study.Inclusion: ≥ age 60, lived in independent housing in the com- munity, and ≥ 16 on the CES-D at baselineDepressive symptoms: CES–DChanges between baseline and 3-year follow-up examined using Wilcoxon signed rank testsDepressive symptoms decreased over the 3-year period (25.7 at baseline to 22.3).Assistive devices were measured by self-report of participants and include items that may not have been obtained to compensate for declining abilities (e.g., TV remotes, cordless phones).
Data were collected from 1991 to 2001 to examine coping strategies of elders with disabilities.N = 73; mean age = 73.6, 81% female, 83.6% White, mean CES–D score = 25.7Impairment–disability status: OARS (vision–hearing impairment and IADL disability); MMSE; Sickness Impact Profile; FIM (disability)Predictors of changes in depression over the 3-year period examined by means of Kruskal–Wallis tests.Assistive device usage increased over time (from 11.9 at baseline to 17.9).Differences in inter-view administration by interviewers may have resulted in differing responses from participants.
N = 791 in datasetAssistive devices: assistive technology survey (use of and satisfaction with devices for physical disabilities; hearing, visual, or cognitive impairments)Predictors of CES-D change were number of illnesses, mental status, hearing impairment severity, number of days ill, QoL, and life satisfaction.Link to OT practice not clear.
Murphy, Smith, & Alexander (2008) Cohort studyn/aWomen with symptomatic knee or hip OA were recruited from fliers or a university subject registry in southeastern Michigan.Inclusion: age 55-80, ≥24 on MMSE, English-speaking, could operate actigraph device used in the study, X-ray evidence of OA in the knee or hip, and at least mild pain on the WOMAC pain scaleData collected using ecological momentary assessment over a 5-day period. Wrist-worn actigraph device beeped and participants recorded pain and fatigue, (severity [0–4] scales), activity pacing (frequency of use of pacing strategies on 0-4 scale), and physical activity (measured continuously by actigraph device [wrist-worn accelerometer]).t tests; hierarchical linear modelsHigh-activity pacers experienced significantly higher levels of morning fatigue and trends of higher morning pain, overall pain, and overall fatigue compared with low activity pacers.Further psychometric work on activity pacing scale needed.
Exclusion: nonambulatory, had other medical conditions that interfered with activities, or recent knee or hip joint replacementPhysical activity levels were lower for high activity pacers.Sample was small, primarily White, and well-educated, limiting generalizability.
N = 30; mean age = 63.8, SD = 6.9Activity pacing was independently associated with lower levels of physical activity.
Schmid & Rittman (2009) Qualitativen/aData obtained from ongoing longitudinal study to examine recovery patterns after stroke. All participants experienced an acute stroke, were discharged home, and continued to receive medical or rehabilitation.Inclusion: discussed poststroke falls without prompting during the 1-month or 6-month qualitative interviews; male; White, African-American, or Puerto Rican Hispanic; discharged directly home from an acute care unit; scored ≥18 on MMSE; able to communicate verbally at discharge; had a caregiver willing to participaten/an/aPrimary consequences of post-stroke falls were a limitation in activities or participation, increased dependence, and development of fear of falling.Generalizability not possible in qualitative studies.
N = 132 in datasetN = 42, mean age = 66.3, SD = 7.8Communication about falling was not collected systematically and was provided without prompting by par ticipants; therefore, the experience of falls may not be fully captured in this sample.
Table Footer NoteNote. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.
Note. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.×
Table 2.
Productive Aging Articles Published in AJOT in 2008–2009
Productive Aging Articles Published in AJOT in 2008–2009×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion–Exclusion CriteriaInstruments, Measures, and Interventions UsedStatistics UsedResultsStudy Limitations
Hunt & Arbesman (2008) SRISearch terms developed by project coordinator, author of each review, and advisory board. Medical librarian assisted in article search.Literature search: peer-reviewed literature between 1980 and 2004; searching done in online databasesVisual, cognitive, and motor interventions: Visual attention—Useful Field of View Test; oculomotor skills and eye–hand coordination—Dynavision; home exercise programn/aRemediation of visual, cognitive, or motor deficits improves skillsUnclear whether studies that focus on skill remediation are translatable to on-road performance. Effects could reflect learning because the training tool was often also used as the assessment measure.
Inclusion: studies with OT in intervention or within the scope of OT practice and included interventions to the person, including family involvement and role of passengersEducational interventions: driver education, self-awareness–regulation programs, driving simulatorsDriving education programs and effect-of-passengers studies had mixed results.SR limited by heterogeneity in study quality, including lack of randomization, no control groups, small sample size, self-reported outcomes.
19 articles (10 Level I, 6 Level II, 3 Level III)Effect of passengers; medical interventions: cataract surgery, cognition-enhancing drugsMedical interventions showed positive effects on balance, decreased crash rate, and driving performance.
Stav (2008) SRISame as Hunt & Arbesman (2008) Literature search: Same as Hunt & Arbesman (2008) Policy interventions:n/aMore stringent relicensure policies reduced traffic-related fatalities; in Finland, more stringent policies in licensing of older adults may be linked to increased fatalities in this age group using alternative transportation.More inclusive outcome measures needed in policy studies (beyond data on short-term fatalities that may not fully capture crash incidents).
Inclusion: studies with policy interventions related to licensure restrictions, relicensing criteria, and retesting community mobility interventions related to program effectiveness or program evaluationIncreased testing during license renewal (e.g., visual screening, on-road testing), scores on performance tests, restricted or conditional licensingOutcomes do not include effects on participation or quality of life, which are often of most interest for OT intervention.
7 articles (6 Level II, 1 Level III)Community interventions: Alternative transportation programResearch into community mobility is lacking.
Bohr (2008) SRISame as Hunt & Arbesman (2008) Literature search: peer-reviewed literature between 1999 and 2004Legibility and identification of road signs, lane markings, and walking pace at crosswalksn/aInfrastructure studies showed font type, reflective coating, and traffic sign position affect sign visibility and legibility. Age differences in reaction time, identification errors, and eye fixation found during testing. Differences between indoor and outdoor walking paces were found, suggesting the influence of outdoor environmental conditions.Many studies may not generalize to on-road conditions because they were simulated or performed under only clear and dry weather conditions.
Searching done in online databases primarily in human factors and engineering fields
Guidelines for infrastructure before 1999 taken from a Federal Highway Administration handbook
Inclusion: studies that investigated infrastructure modifications of the physical environment on driving ability, performance, or safety
8 articles (6 Level I, 2 Level III)
Arbesman & Pellerito (2008) SRISame as Hunt & Arbesman (2008) Literature search: same as Hunt & Arbesman (2008) Modifications included window tinting, wind-shield angle, reflectance, familiarity with instrument panel.n/aModifications such as window tinting have negative affects on older adults’ driving performance.Lack of randomization, limited applicability to real-world driving in some studies.
Inclusion: Studies that related to impact of automobile-related modification typesAdaptive equipment included ITS (e.g., in-vehicle navigation and visual enhancement systems).Adaptive equipment shows positive effects in performance and satisfaction in use of some ITS.Lack of studies found in the use of low-tech adaptive equipment (cushions, mirrors, grab bars) and crash safety that may be important for OT interventions
22 articles: 7 on modifications for visibility and adaptive equipment (4 Level I, 3 Level II); 15 on ITS (6 Level I, 7 Level II, 2 Level III)
Kay, Bundy, & Clemson (2009) Preliminary validity studyn/aProspective cohort study, recruitment from two driving rehabilitation centers in Sydney, New South Wales, AustraliaInclusion: having a neurological condition and a diagnosis known to be associated with impaired awareness, ≥ age 60, referred for a driving assessmentDriveAware QuestionnaireKappa to measure agreement of level of awareness in ability between off-road and on-road assessment of driving ability.Substantial agreement (κ = .69) exists between rating of awareness of driving ability before and after on-road assessment.Not clear how 60 participants were selected.
N = 60; 72% sample was male; 77% had either mild cognitive impairment or dementia, and others had stroke, Parkinson’s disease, or other diseases.Although therapists during the on-road assessment were initially blinded to the therapist who rated participants in the off-road assessment, blinding could be breeched by the driving evaluator, who had knowledge of the first therapist’s evaluation.
Different therapists conducted on-road assessments; inter-rater reliability between therapists was not reported.
Classen, Awadzi, & Mkanta (2008) Secondary data analysis, cohortn/aU.S. Dept of Transportation 2003 Fatality Analysis Reporting System, a national crash database that contains census data on all crashes on public roads that result in at least one fatality 30 days after the crashInclusion: ≥ age 65 and involved in at least one auto crash in 2003Used theoretical model (Precede Proceed Model of Health Promotion) to identify person, vehicle, and environmental factors related to driving performance.Log-linear modeling to measure two-way interactions among person, vehicle, and environment factorsPerson–environment interactions: Gender differences in when crashes occurredCross-sectional data limit causal inferences.
N = 5,744, 66.6% male, mean age = 75.96, SD = 7.11Vehicle–environment interactions: Crash type varied by time of dayCrashes in dataset were limited to those that involved a fatality. Less serious crashes would also be important to examine for older adults.
Finlayson, Garcia, & Cho (2008) Secondary data analysis, cross-sectional descriptive studyn/aDatabase constructed to examine aging in MS and unmet health-related service needs. It targeted people living in the midwestern United States.Inclusion: ≥ age 45 with a self-reported diagnosis of MSExamined factors associated with use of OT services.Proportional odds models62% of participants had never used OT services as part of their care.OT service patterns in small geographic region may not generalize.
N = 1,282; mean age = 63.8, SD = 9.4; 74% female, mean duration of disease = 20 years, SD = 11.4Most recent users of OT were those residing in an urban or suburban area and those who lived alone. Use of OT was associated with extent of ADL limitations (most recent use associated with highest ADL limitations).OT service use was measured through participant recall.
Finlayson, Shevil, & Cho (2009) Cross-sectional, descriptive studyn/aDataset same as Finlayson, Garcia, & Cho (2008) . N = 1,003; all provided permission to contact their caregivers. Individual caregivers were stratified according to age of participants they cared for who had MS (45–64 or ≥65), and participants were randomly selected to complete an interview.Inclusion: caregiver and participant dyadsAgreement between participants with MS and their caregivers on extent of cognitive symptoms was measured.Kappa and ICC to examine agreement; multi-nomial regression to examine characteristics61 % of participants with MS reported that cognitive symptoms interfered with activity engagement.Questions posed to caregivers and participants with MS about cognitive symptoms not worded identically and relied on self-report.
N = 279 participants with MS (mean age = 62.8, SD = 9.4), mean duration of disease = 18.3 years, SD = 11.8Characteristics of those participants with discrepancies in agreement with care-giver were examined.Fair agreement between caregiver and participants with MS (κ = .39)Gap in time between caregiver interview and participants was several months, during which time cognitive symptoms may have changed.
ICC = .2, (20% of total variation in responses can be attributed to within-pair discrepancies)
Discrepancies in agreement associated with greater disease duration (caregiver noted symptoms more often) and being female (participant noted symptoms more often)
Haak, Fange, Horstmann, & Iwarsson (2008) Secondary data analysis, descriptive study, validity studyn/aENABLE–AGE database of 5 European countries examining home environment and participation in very old people (N = 1,918). Involved baseline interview and follow-up period at 1-year interval (T1 and T2).Sample drawn at random from Swedish Central Population Register and stratified by age and gender.Examined relationship between the housing and neighborhood environments at T1 and two dimensions of participation at T2.Spearman rank correlation coefficientsAspects of housing and neighborhood environment more strongly related to performance-oriented participation and related less strongly to togetherness-oriented participation.1-year gap between environmental factors and participation outcomes may affect relationship.
Inclusion: people ≥ age 80 living alone in 3 Swedish municipalities with sufficient data at T1 and T2Performance oriented and togetherness orientedCriteria for determining sufficient evidence for validity on each dimension are unclear.
N = 314; at T1, median age = 85; 26% were male
median of 2 functional limitations
Yuen, Huang, Burik, & Smith (2008) Randomized controlled trialI5 LTC facilitiesInclusion: resident of LTC facility, ≥ age, spoke English as first language, able to converse for 1 hr, intelligible speech, MMSE score ≥ 19Intervention: Mentoring group—resident mentored an ESL student 2 times a week for 12 weeks with initial orientation by English language teachers.Multi-variate nonparametric global statistic to measure change scores from baseline to post-test and baseline to 3-month follow-upBoth groups had deteriorating well-being over the testing period, but the mentoring group had less deterioration that was statistically significant.Risk of attention bias because usual-care group did not control for attention.
Recruitment by authors meeting with facility staff and with residents of each facilityExclusion: uncorrectable hearing impairments, known maladaptive behavior patterns, psychotic symptoms, and illness with <6 months projected survivalUsual care: No intervention provided.Risk of attrition bias. There was a 28% attrition rate before postintervention data collection, and analysis included data of only participants who completed baseline and follow-up assessments.
ESL students recruited from 3 ESL schools.N = 39, randomized; final N = 28; mean age = 83.4, SD = 8.8; 71.4% female, mean months in LTC = 27.4Instruments used to measure main “well-being” outcomes:Not clear whether statistically significant results translate into clinical meaningful differences.
Geriatric Depression Scale, LSI–A, self-rated healthSmall sample limits generalizability.
Wood, Womack, & Hooper (2009) Case studyn/a2 Alzheimer’s special care units with different social and physical environments selected from centers identified by a local Area Agency on AgingInclusion: diagnosis of Alzheimer’s or neuro-degenerative dementia, ability to walk with or without assistance, ability to communicate needs, resided in SCU for ≥6 monthsActivity in Context and Time, computer-assisted tool to record environmental correlates of time use and affect of people with dementiaMean proportions of time spent in specific activities and affect states calculated.Daily time use and affect suggest that participants had capacities that were infrequently tapped in their activity experiences.Generalization of findings overall, site comparisons, and causal relationships limited because of case study design.
Exclusion: history of or current psychotic illnesses or major depressionStudy involved observation (12 hr per day for 4 days) of each participant by 1 of 4 observers. Codes representing dimensions of time use and affect and considered QoL indicators were recorded by observers.Correlations between specific activities and QoL indicatorsSome site differences found in engagement and affect at the traditional SCU compared with the homelike facility.
Participants at sites matched by age, gender, and functional status
N = 14; mean age = 81 at Site 1; mean age = 83 at Site 2
Mann et al. (2008) Secondary data analysis, longitudinal cohort studyn/aData were from Rehabilitation Engineering Research Center on Aging Consumer Assessments Study.Inclusion: ≥ age 60, lived in independent housing in the com- munity, and ≥ 16 on the CES-D at baselineDepressive symptoms: CES–DChanges between baseline and 3-year follow-up examined using Wilcoxon signed rank testsDepressive symptoms decreased over the 3-year period (25.7 at baseline to 22.3).Assistive devices were measured by self-report of participants and include items that may not have been obtained to compensate for declining abilities (e.g., TV remotes, cordless phones).
Data were collected from 1991 to 2001 to examine coping strategies of elders with disabilities.N = 73; mean age = 73.6, 81% female, 83.6% White, mean CES–D score = 25.7Impairment–disability status: OARS (vision–hearing impairment and IADL disability); MMSE; Sickness Impact Profile; FIM (disability)Predictors of changes in depression over the 3-year period examined by means of Kruskal–Wallis tests.Assistive device usage increased over time (from 11.9 at baseline to 17.9).Differences in inter-view administration by interviewers may have resulted in differing responses from participants.
N = 791 in datasetAssistive devices: assistive technology survey (use of and satisfaction with devices for physical disabilities; hearing, visual, or cognitive impairments)Predictors of CES-D change were number of illnesses, mental status, hearing impairment severity, number of days ill, QoL, and life satisfaction.Link to OT practice not clear.
Murphy, Smith, & Alexander (2008) Cohort studyn/aWomen with symptomatic knee or hip OA were recruited from fliers or a university subject registry in southeastern Michigan.Inclusion: age 55-80, ≥24 on MMSE, English-speaking, could operate actigraph device used in the study, X-ray evidence of OA in the knee or hip, and at least mild pain on the WOMAC pain scaleData collected using ecological momentary assessment over a 5-day period. Wrist-worn actigraph device beeped and participants recorded pain and fatigue, (severity [0–4] scales), activity pacing (frequency of use of pacing strategies on 0-4 scale), and physical activity (measured continuously by actigraph device [wrist-worn accelerometer]).t tests; hierarchical linear modelsHigh-activity pacers experienced significantly higher levels of morning fatigue and trends of higher morning pain, overall pain, and overall fatigue compared with low activity pacers.Further psychometric work on activity pacing scale needed.
Exclusion: nonambulatory, had other medical conditions that interfered with activities, or recent knee or hip joint replacementPhysical activity levels were lower for high activity pacers.Sample was small, primarily White, and well-educated, limiting generalizability.
N = 30; mean age = 63.8, SD = 6.9Activity pacing was independently associated with lower levels of physical activity.
Schmid & Rittman (2009) Qualitativen/aData obtained from ongoing longitudinal study to examine recovery patterns after stroke. All participants experienced an acute stroke, were discharged home, and continued to receive medical or rehabilitation.Inclusion: discussed poststroke falls without prompting during the 1-month or 6-month qualitative interviews; male; White, African-American, or Puerto Rican Hispanic; discharged directly home from an acute care unit; scored ≥18 on MMSE; able to communicate verbally at discharge; had a caregiver willing to participaten/an/aPrimary consequences of post-stroke falls were a limitation in activities or participation, increased dependence, and development of fear of falling.Generalizability not possible in qualitative studies.
N = 132 in datasetN = 42, mean age = 66.3, SD = 7.8Communication about falling was not collected systematically and was provided without prompting by par ticipants; therefore, the experience of falls may not be fully captured in this sample.
Table Footer NoteNote. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.
Note. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.×
×
Of the 14 articles related to productive aging published in AJOT in 2008–2009, 50% were basic research articles (n = 7). These articles examined a clinical phenomenon but did not assess treatment (Classen, Awadzi, & Mkanta, 2008; Finlayson, Garcia, & Cho, 2008; Finlayson, Shevil, & Cho, 2009; Haak, Fange, Horstmann, & Iwarsson, 2008; Mann et al., 2008; Murphy, Smith, & Alexander, 2008; Schmid & Rittman, 2009). However, many of these articles extended the knowledge that can be linked to implications for clinical practice. For example, Finlayson et al. (2009)  discussed their findings regarding discrepancies in the perception of cognitive symptoms between people who have multiple sclerosis and their caregivers in terms of how they can affect occupational therapy treatment. In addition, Schmid and Rittman (2009)  outlined several clinical issues that could enhance occupational therapy treatment for managing falls and fall risk among people who had a stroke, including caregiver education, medication management, and intervention to reduce fear of falling and associated activity curtailment.
One article (7%) pertained to instrument development and testing (Kay, Bundy, & Clemson, 2009). Kay et al. (2009)  examined whether the DriveAware assessment, a five-item self-report questionnaire administered and rated by clinicians, could tap awareness of driving ability. Agreement between a clinician’s rating of awareness before and after on-road testing was examined. Further examination of this questionnaire’s psychometric properties is ongoing; however, Kay et al. discussed future implications for occupational therapy clinicians. Because lack of awareness has been associated with unsafe driving, using a simple scale in place of costly and unsafe on-road tests may provide a great benefit.
Of the 14 articles on productive aging, 13 used quantitative methods (93%). One study had an instrumental case study design that used both qualitative and quantitative methods (Wood et al., 2009), and 1 study was qualitative (Schmid & Rittman, 2009).
How Well Did AJOT Meet the Centennial Vision in 2008 and 2009 in the Area of Productive Aging?
Taken as a whole, this body of research shows that the evidence for occupational therapy’s effectiveness for use in practice to facilitate productive aging is still limited. Most studies were classified as basic research, and although several pertained to specific practice issues and some used groups of older adults with a particular disease or condition (e.g., multiple sclerosis, stroke, osteoarthritis), the articles were difficult to synthesize. The articles in general articulated occupational therapy’s role in existing or emerging practice areas and may reflect where the discipline is at in terms of providing a foundation for future intervention work.
To examine evidence of the effectiveness of occupational therapy, I used the evidence rating system from AOTA’s Evidence-Based Literature Review Project (Lieberman & Sheer, 2002). These levels range from I (highest level of evidence) to V (lowest level of evidence) according to the rigor of the study design, not necessarily the quality of the study. Level I includes systematic reviews and randomized controlled trials; Level II includes two-group nonrandomized trials; Level III includes one-group nonrandomized trials; Level IV includes single-subject designs, descriptive studies, and case series or case reports using objective measures; and Level V includes expert opinion (Lieberman & Sheer, 2002).
The strongest evidence for the use of occupational therapy in productive aging is in the area of driving. The four systematic reviews on aspects of driving interventions are considered Level I evidence and are of high quality. Of the 56 studies used in the systematic review articles, I should note that only 3 studies (5%) came from the occupational therapy literature (Stav, Arbesman, & Lieberman, 2008). Despite the lack of occupational therapy–driven research, each review discussed the relevance of the different aspects of interventions to occupational therapy. Reviews such as these can assist practitioners in disentangling the body of evidence related to a practice area and can educate practitioners about their role. On the basis of the systematic reviews on driving, information gleaned from reviews of interventions related to the person’s driving abilities (Hunt & Arbesman, 2008) and community mobility programs (Stav, 2008) may directly affect the type of occupational therapy treatment provided and may foster future occupational therapy research. Reviews on physical infrastructure (Bohr, 2008) and automobile modifications (Arbesman & Pellerito, 2008) are not within the realm of interventions provided by occupational therapists, but practitioners need to know this information to fully understand what factors affect driving performance and be a knowledgeable consultant to policymakers, engineers, and urban planners.
In 2008 and 2009, AJOT published only one randomized controlled trial related to productive aging (Yuen et al., 2008). The study examined the effectiveness of participating in a volunteer activity (mentoring a student for whom English was a second language) on measures of well-being. Although the design was rigorous (randomized controlled trial), the positive results could possibly have been inflated by comparing the volunteer group with a nonattention control group and including only people who completed the intervention in the analyses. Whether participants benefited from the program because it compensated for loss of a valued role, as hypothesized, or for another reason, such as being an outlet for social interaction, remains to be determined. In addition, because the treatment is not an occupational therapy intervention, the future practice implications are ones in which the occupational therapist is a facilitator of services rather than a direct service provider.
Research Gaps and Future Directions to Meet the Centennial Vision
On the basis of the past 2 years of geriatric research in AJOT, the discipline appears to still be at the beginning stages of knowledge building in productive aging. Many of the basic research articles have discussed occupational therapy’s role in emerging areas of practice. However, research on intervention development and examination of the effectiveness and efficacy of interventions will need to be conducted to establish these roles in multidisciplinary arenas. The continued emphasis on training new occupational therapy researchers will be critical to move beyond basic research and build evidence in these areas.
The systematic reviews on driving not only have served occupational therapy by defining practice roles and by synthesizing current evidence but also have clearly shown gaps in research for which occupational therapy needs to take a leading position. Because the aging U.S. population will necessitate a huge need for these services, occupational therapy needs to mobilize research efforts to examine the effectiveness of driving interventions to stay viable in this area.
Future research on instrument development is also needed to adequately measure outcomes related to occupational performance. In addition, research linking occupational engagement to health will be important to build on to advance occupational therapy as a discipline. These types of theoretically grounded articles can facilitate translation into practice and provide a foundation to examine effectiveness of occupational therapy interventions.
This review provides an overview of effectiveness research published in AJOT in 2008 and 2009. I should mention that occupational therapy effectiveness research has been published in journals outside of AJOT and the profession during this time period (e.g., Di Monaco et al., 2008; Eklund, Sjostrand, & Dahlin-Ivanoff, 2008; Gitlin et al., 2009; Murphy, Strasburg, et al., 2008). Publishing occupational therapy effectiveness research outside of AJOT may reflect pressures to publish in higher impact journals or the need to reach specific, multidisciplinary audiences. Future reviews of productive aging research may need to include multiple journals to examine more broadly how occupational therapy is meeting the Centennial Vision in geriatric research.
In conclusion, occupational therapy will need to build on the productive aging research evidence base in the years ahead to address the growing practice needs of the aging population. The foundation provided in the past 2 years in AJOT is a promising beginning. However, more research is needed to build on these initial studies and provide the evidence that will clearly specify occupational therapy’s role in productive aging and justify service reimbursement.
American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. [Article]
American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. [Article] ×
Arbesman, M., & Pellerito, J. M., Jr. (2008). Evidence-based perspective on the effect of automobile-related modifications on the driving ability, performance, and safety of older adults. American Journal of Occupational Therapy, 62, 173–186. [Article] [PubMed]
Arbesman, M., & Pellerito, J. M., Jr. (2008). Evidence-based perspective on the effect of automobile-related modifications on the driving ability, performance, and safety of older adults. American Journal of Occupational Therapy, 62, 173–186. [Article] [PubMed]×
Bohr, P. C. (2008). Critical review and analysis of the impact of the physical infrastructure on the driving ability, performance, and safety of older adults. American Journal of Occupational Therapy, 62, 159–172. [Article] [PubMed]
Bohr, P. C. (2008). Critical review and analysis of the impact of the physical infrastructure on the driving ability, performance, and safety of older adults. American Journal of Occupational Therapy, 62, 159–172. [Article] [PubMed]×
Case-Smith, J., & Powell, C. A. (2008). Concepts in Clinical Scholarship—Research literature in occupational therapy, 2001–2005. American Journal of Occupational Therapy, 62, 480–486. [Article] [PubMed]
Case-Smith, J., & Powell, C. A. (2008). Concepts in Clinical Scholarship—Research literature in occupational therapy, 2001–2005. American Journal of Occupational Therapy, 62, 480–486. [Article] [PubMed]×
Classen, S., Awadzi, K. D., & Mkanta, W. W. (2008). Person–vehicle–environment interactions in predicting crash-related injury among older drivers. American Journal of Occupational Therapy, 62, 580–587. [Article] [PubMed]
Classen, S., Awadzi, K. D., & Mkanta, W. W. (2008). Person–vehicle–environment interactions in predicting crash-related injury among older drivers. American Journal of Occupational Therapy, 62, 580–587. [Article] [PubMed]×
Corcoran, M. (2007). AJOT and the AOTA Centennial Vision (From the Desk of the Editor). American Journal of Occupational Therapy, 61, 267–268. [Article]
Corcoran, M. (2007). AJOT and the AOTA Centennial Vision (From the Desk of the Editor). American Journal of Occupational Therapy, 61, 267–268. [Article] ×
Day, J. C. (1996). Population projections of the United States by age, sex, race and Hispanic origin: 1995–2050 (Current Population Reports, P25–P1130). Washington, DC: U.S. Government Printing Office. Retrieved from www.census.gov/prod/1/pop/p25-1130.pdf
Day, J. C. (1996). Population projections of the United States by age, sex, race and Hispanic origin: 1995–2050 (Current Population Reports, P25–P1130). Washington, DC: U.S. Government Printing Office. Retrieved from www.census.gov/prod/1/pop/p25-1130.pdf×
Di Monaco, M., Vallero, F., De Toma, E., De Lauso, L., Tappero, R., & Cavanna, A. (2008). A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: A quasi-randomized controlled trial. Journal of Rehabilitation Medicine, 40, 446–454. [Article] [PubMed]
Di Monaco, M., Vallero, F., De Toma, E., De Lauso, L., Tappero, R., & Cavanna, A. (2008). A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: A quasi-randomized controlled trial. Journal of Rehabilitation Medicine, 40, 446–454. [Article] [PubMed]×
Eklund, K., Sjostrand, J., & Dahlin-Ivanoff, S. (2008). A randomized controlled trial of a health-promotion programme and its effect on ADL dependence and self-reported health problems for the elderly visually impaired. Scandinavian Journal of Occupational Therapy, 15, 68–74. [Article] [PubMed]
Eklund, K., Sjostrand, J., & Dahlin-Ivanoff, S. (2008). A randomized controlled trial of a health-promotion programme and its effect on ADL dependence and self-reported health problems for the elderly visually impaired. Scandinavian Journal of Occupational Therapy, 15, 68–74. [Article] [PubMed]×
Finlayson, M., Garcia, J. D., & Cho, C. (2008). Occupational therapy service use among people aging with multiple sclerosis. American Journal of Occupational Therapy, 62, 320–328. [Article] [PubMed]
Finlayson, M., Garcia, J. D., & Cho, C. (2008). Occupational therapy service use among people aging with multiple sclerosis. American Journal of Occupational Therapy, 62, 320–328. [Article] [PubMed]×
Finlayson, M., Shevil, E., & Cho, C. C. (2009). Perceptions of cognitive symptoms among people aging with multiple sclerosis and their caregivers. American Journal of Occupational Therapy, 63, 151–159. [Article] [PubMed]
Finlayson, M., Shevil, E., & Cho, C. C. (2009). Perceptions of cognitive symptoms among people aging with multiple sclerosis and their caregivers. American Journal of Occupational Therapy, 63, 151–159. [Article] [PubMed]×
Gitlin, L. N., Hauck, W. W., Dennis, M. P., Winter, L., Hodgson, N., & Schinfeld, S. (2009). Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: Results from a randomized trial. Journal of the American Geriatrics Society, 57, 476–481. [Article] [PubMed]
Gitlin, L. N., Hauck, W. W., Dennis, M. P., Winter, L., Hodgson, N., & Schinfeld, S. (2009). Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: Results from a randomized trial. Journal of the American Geriatrics Society, 57, 476–481. [Article] [PubMed]×
Gutman, S. A. (2008). Research priorities of the profession (From the Desk of the Editor). American Journal of Occupational Therapy, 62, 499–501. [Article] [PubMed]
Gutman, S. A. (2008). Research priorities of the profession (From the Desk of the Editor). American Journal of Occupational Therapy, 62, 499–501. [Article] [PubMed]×
Gutman, S. A. (2009). Why haven’t we generated sufficient evidence? Part I: Barriers to applied research. American Journal of Occupational Therapy, 63, 381–383.
Gutman, S. A. (2009). Why haven’t we generated sufficient evidence? Part I: Barriers to applied research. American Journal of Occupational Therapy, 63, 381–383.×
Haak, M., Fange, A., Horstmann, V., & Iwarsson, S. (2008). Two dimensions of participation in very old age and their relationships to home and neighborhood environments. American Journal of Occupational Therapy, 62, 77–86. [Article] [PubMed]
Haak, M., Fange, A., Horstmann, V., & Iwarsson, S. (2008). Two dimensions of participation in very old age and their relationships to home and neighborhood environments. American Journal of Occupational Therapy, 62, 77–86. [Article] [PubMed]×
Hunt, L. A., & Arbesman, M. (2008). Evidence-based and occupational perspective of effective interventions for older clients that remediate and support improved driving performance. American Journal of Occupational Therapy, 62, 136–148. [Article] [PubMed]
Hunt, L. A., & Arbesman, M. (2008). Evidence-based and occupational perspective of effective interventions for older clients that remediate and support improved driving performance. American Journal of Occupational Therapy, 62, 136–148. [Article] [PubMed]×
Kay, L. G., Bundy, A. C., & Clemson, L. (2009). Awareness of driving ability in senior drivers with neurological conditions. American Journal of Occupational Therapy, 63, 146–150. [Article] [PubMed]
Kay, L. G., Bundy, A. C., & Clemson, L. (2009). Awareness of driving ability in senior drivers with neurological conditions. American Journal of Occupational Therapy, 63, 146–150. [Article] [PubMed]×
Lieberman, D., & Sheer, J. (2002). AOTA’s evidence-based literature review project: An overview. American Journal of Occupational Therapy, 56, 344–349. [Article] [PubMed]
Lieberman, D., & Sheer, J. (2002). AOTA’s evidence-based literature review project: An overview. American Journal of Occupational Therapy, 56, 344–349. [Article] [PubMed]×
Mann, W. C., Johnson, J. L., Lynch, L. G., Justiss, M. D., Tomita, M., & Wu, S. S. (2008). Changes in impairment level, functional status, and use of assistive devices by older people with depressive symptoms. American Journal of Occupational Therapy, 62, 9–17. [Article] [PubMed]
Mann, W. C., Johnson, J. L., Lynch, L. G., Justiss, M. D., Tomita, M., & Wu, S. S. (2008). Changes in impairment level, functional status, and use of assistive devices by older people with depressive symptoms. American Journal of Occupational Therapy, 62, 9–17. [Article] [PubMed]×
Murphy, S. L., Smith, D. M., & Alexander, N. B. (2008). Measuring activity pacing in women with lower-extremity osteoarthritis: A pilot study. American Journal of Occupational Therapy, 62, 329–334. [Article] [PubMed]
Murphy, S. L., Smith, D. M., & Alexander, N. B. (2008). Measuring activity pacing in women with lower-extremity osteoarthritis: A pilot study. American Journal of Occupational Therapy, 62, 329–334. [Article] [PubMed]×
Murphy, S. L., Strasburg, D. M., Lyden, A. K., Smith, D. M., Koliba, J. F., Dadabhoy, D. P., et al. (2008). Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: A pilot study. Arthritis and Rheumatism, 59, 1480–1487. [Article] [PubMed]
Murphy, S. L., Strasburg, D. M., Lyden, A. K., Smith, D. M., Koliba, J. F., Dadabhoy, D. P., et al. (2008). Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: A pilot study. Arthritis and Rheumatism, 59, 1480–1487. [Article] [PubMed]×
Schmid, A. A., & Rittman, M. (2009). Consequences of post-stroke falls: Activity limitation, increased dependence, and the development of fear of falling. American Journal of Occupational Therapy, 63, 310–316. [Article] [PubMed]
Schmid, A. A., & Rittman, M. (2009). Consequences of post-stroke falls: Activity limitation, increased dependence, and the development of fear of falling. American Journal of Occupational Therapy, 63, 310–316. [Article] [PubMed]×
Stav, W. B. (2008). Review of the evidence related to older adult community mobility and driver licensure policies. American Journal of Occupational Therapy, 62, 149–158. [Article] [PubMed]
Stav, W. B. (2008). Review of the evidence related to older adult community mobility and driver licensure policies. American Journal of Occupational Therapy, 62, 149–158. [Article] [PubMed]×
Stav, W. B., Arbesman, M., & Lieberman, D. (2008). Background and methodology of the older driver evidence-based systematic literature review. American Journal of Occupational Therapy, 62, 130–135. [Article] [PubMed]
Stav, W. B., Arbesman, M., & Lieberman, D. (2008). Background and methodology of the older driver evidence-based systematic literature review. American Journal of Occupational Therapy, 62, 130–135. [Article] [PubMed]×
Sussman, S., Valente, T. W., Rohrbach, L. A., Skara, S., & Pentz, M. A. (2006). Translation in the health professions: Converting science into action. Evaluation and the Health Professions, 29, 7–32. [Article] [PubMed]
Sussman, S., Valente, T. W., Rohrbach, L. A., Skara, S., & Pentz, M. A. (2006). Translation in the health professions: Converting science into action. Evaluation and the Health Professions, 29, 7–32. [Article] [PubMed]×
U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and improving health (2nd ed., Vols. 1 and 2). Washington, DC: U.S. Government Printing Office. Retrieved from www.healthypeople.gov/Document/tableofcontents.htm
U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and improving health (2nd ed., Vols. 1 and 2). Washington, DC: U.S. Government Printing Office. Retrieved from www.healthypeople.gov/Document/tableofcontents.htm×
Wood, W., Womack, J., & Hooper, B. (2009). Dying of boredom: An exploratory case study of time use, apparent affect, and routine activity situations on two Alzheimer’s special care units. American Journal of Occupational Therapy, 63, 337–350. [Article] [PubMed]
Wood, W., Womack, J., & Hooper, B. (2009). Dying of boredom: An exploratory case study of time use, apparent affect, and routine activity situations on two Alzheimer’s special care units. American Journal of Occupational Therapy, 63, 337–350. [Article] [PubMed]×
Yuen, H. K., Huang, P., Burik, J. K., & Smith, T. G. (2008). Impact of participating in volunteer activities for residents living in long-term care facilities. American Journal of Occupational Therapy, 62, 71–76. [Article] [PubMed]
Yuen, H. K., Huang, P., Burik, J. K., & Smith, T. G. (2008). Impact of participating in volunteer activities for residents living in long-term care facilities. American Journal of Occupational Therapy, 62, 71–76. [Article] [PubMed]×
Figure 1.
Types of productive aging articles published in the American Journal of Occupational Therapy in 2008–2009.
Figure 1.
Types of productive aging articles published in the American Journal of Occupational Therapy in 2008–2009.
×
Table 1.
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence×
Author and YearEffectiveness StudySystematic–Narrative ReviewEfficacy Study Basic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Hunt & Arbesman (2008) XQuantitativeI
Stav (2008) XQuantitativeI
Bohr (2008) XQuantitativeI
Arbesman & Pellerito (2008) XQuantitativeI
Kay, Bundy, & Clemson (2009) XQuantitative
Classen, Awadzi, & Mkanta (2008) XQuantitative
Finlayson, Garcia, & Cho (2008) XQuantitative
Finlayson, Shevil, & Cho (2009) XQuantitative
Haak, Fange, Horstmann, & Iwarsson (2008) XQuantitativeI
Yuen, Huang, Burik, & Smith (2008) XQuantitative
Wood, Womack, & Hooper (2009) XMixed method
Mann et al. (2008) XQuantitative
Murphy, Smith, & Alexander (2008) XQuantitative
Schmid & Rittman (2009) XQualitative
Table 1.
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence
Productive Aging Articles Published in the American Journal of Occupational Therapy in 2008–2009, by Type and Level of Evidence×
Author and YearEffectiveness StudySystematic–Narrative ReviewEfficacy Study Basic ResearchInstrument Development and TestingLink Between Occupational Engagement and HealthQuantitative, Qualitative, or Mixed MethodLevel of Evidence
Hunt & Arbesman (2008) XQuantitativeI
Stav (2008) XQuantitativeI
Bohr (2008) XQuantitativeI
Arbesman & Pellerito (2008) XQuantitativeI
Kay, Bundy, & Clemson (2009) XQuantitative
Classen, Awadzi, & Mkanta (2008) XQuantitative
Finlayson, Garcia, & Cho (2008) XQuantitative
Finlayson, Shevil, & Cho (2009) XQuantitative
Haak, Fange, Horstmann, & Iwarsson (2008) XQuantitativeI
Yuen, Huang, Burik, & Smith (2008) XQuantitative
Wood, Womack, & Hooper (2009) XMixed method
Mann et al. (2008) XQuantitative
Murphy, Smith, & Alexander (2008) XQuantitative
Schmid & Rittman (2009) XQualitative
×
Table 2.
Productive Aging Articles Published in AJOT in 2008–2009
Productive Aging Articles Published in AJOT in 2008–2009×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion–Exclusion CriteriaInstruments, Measures, and Interventions UsedStatistics UsedResultsStudy Limitations
Hunt & Arbesman (2008) SRISearch terms developed by project coordinator, author of each review, and advisory board. Medical librarian assisted in article search.Literature search: peer-reviewed literature between 1980 and 2004; searching done in online databasesVisual, cognitive, and motor interventions: Visual attention—Useful Field of View Test; oculomotor skills and eye–hand coordination—Dynavision; home exercise programn/aRemediation of visual, cognitive, or motor deficits improves skillsUnclear whether studies that focus on skill remediation are translatable to on-road performance. Effects could reflect learning because the training tool was often also used as the assessment measure.
Inclusion: studies with OT in intervention or within the scope of OT practice and included interventions to the person, including family involvement and role of passengersEducational interventions: driver education, self-awareness–regulation programs, driving simulatorsDriving education programs and effect-of-passengers studies had mixed results.SR limited by heterogeneity in study quality, including lack of randomization, no control groups, small sample size, self-reported outcomes.
19 articles (10 Level I, 6 Level II, 3 Level III)Effect of passengers; medical interventions: cataract surgery, cognition-enhancing drugsMedical interventions showed positive effects on balance, decreased crash rate, and driving performance.
Stav (2008) SRISame as Hunt & Arbesman (2008) Literature search: Same as Hunt & Arbesman (2008) Policy interventions:n/aMore stringent relicensure policies reduced traffic-related fatalities; in Finland, more stringent policies in licensing of older adults may be linked to increased fatalities in this age group using alternative transportation.More inclusive outcome measures needed in policy studies (beyond data on short-term fatalities that may not fully capture crash incidents).
Inclusion: studies with policy interventions related to licensure restrictions, relicensing criteria, and retesting community mobility interventions related to program effectiveness or program evaluationIncreased testing during license renewal (e.g., visual screening, on-road testing), scores on performance tests, restricted or conditional licensingOutcomes do not include effects on participation or quality of life, which are often of most interest for OT intervention.
7 articles (6 Level II, 1 Level III)Community interventions: Alternative transportation programResearch into community mobility is lacking.
Bohr (2008) SRISame as Hunt & Arbesman (2008) Literature search: peer-reviewed literature between 1999 and 2004Legibility and identification of road signs, lane markings, and walking pace at crosswalksn/aInfrastructure studies showed font type, reflective coating, and traffic sign position affect sign visibility and legibility. Age differences in reaction time, identification errors, and eye fixation found during testing. Differences between indoor and outdoor walking paces were found, suggesting the influence of outdoor environmental conditions.Many studies may not generalize to on-road conditions because they were simulated or performed under only clear and dry weather conditions.
Searching done in online databases primarily in human factors and engineering fields
Guidelines for infrastructure before 1999 taken from a Federal Highway Administration handbook
Inclusion: studies that investigated infrastructure modifications of the physical environment on driving ability, performance, or safety
8 articles (6 Level I, 2 Level III)
Arbesman & Pellerito (2008) SRISame as Hunt & Arbesman (2008) Literature search: same as Hunt & Arbesman (2008) Modifications included window tinting, wind-shield angle, reflectance, familiarity with instrument panel.n/aModifications such as window tinting have negative affects on older adults’ driving performance.Lack of randomization, limited applicability to real-world driving in some studies.
Inclusion: Studies that related to impact of automobile-related modification typesAdaptive equipment included ITS (e.g., in-vehicle navigation and visual enhancement systems).Adaptive equipment shows positive effects in performance and satisfaction in use of some ITS.Lack of studies found in the use of low-tech adaptive equipment (cushions, mirrors, grab bars) and crash safety that may be important for OT interventions
22 articles: 7 on modifications for visibility and adaptive equipment (4 Level I, 3 Level II); 15 on ITS (6 Level I, 7 Level II, 2 Level III)
Kay, Bundy, & Clemson (2009) Preliminary validity studyn/aProspective cohort study, recruitment from two driving rehabilitation centers in Sydney, New South Wales, AustraliaInclusion: having a neurological condition and a diagnosis known to be associated with impaired awareness, ≥ age 60, referred for a driving assessmentDriveAware QuestionnaireKappa to measure agreement of level of awareness in ability between off-road and on-road assessment of driving ability.Substantial agreement (κ = .69) exists between rating of awareness of driving ability before and after on-road assessment.Not clear how 60 participants were selected.
N = 60; 72% sample was male; 77% had either mild cognitive impairment or dementia, and others had stroke, Parkinson’s disease, or other diseases.Although therapists during the on-road assessment were initially blinded to the therapist who rated participants in the off-road assessment, blinding could be breeched by the driving evaluator, who had knowledge of the first therapist’s evaluation.
Different therapists conducted on-road assessments; inter-rater reliability between therapists was not reported.
Classen, Awadzi, & Mkanta (2008) Secondary data analysis, cohortn/aU.S. Dept of Transportation 2003 Fatality Analysis Reporting System, a national crash database that contains census data on all crashes on public roads that result in at least one fatality 30 days after the crashInclusion: ≥ age 65 and involved in at least one auto crash in 2003Used theoretical model (Precede Proceed Model of Health Promotion) to identify person, vehicle, and environmental factors related to driving performance.Log-linear modeling to measure two-way interactions among person, vehicle, and environment factorsPerson–environment interactions: Gender differences in when crashes occurredCross-sectional data limit causal inferences.
N = 5,744, 66.6% male, mean age = 75.96, SD = 7.11Vehicle–environment interactions: Crash type varied by time of dayCrashes in dataset were limited to those that involved a fatality. Less serious crashes would also be important to examine for older adults.
Finlayson, Garcia, & Cho (2008) Secondary data analysis, cross-sectional descriptive studyn/aDatabase constructed to examine aging in MS and unmet health-related service needs. It targeted people living in the midwestern United States.Inclusion: ≥ age 45 with a self-reported diagnosis of MSExamined factors associated with use of OT services.Proportional odds models62% of participants had never used OT services as part of their care.OT service patterns in small geographic region may not generalize.
N = 1,282; mean age = 63.8, SD = 9.4; 74% female, mean duration of disease = 20 years, SD = 11.4Most recent users of OT were those residing in an urban or suburban area and those who lived alone. Use of OT was associated with extent of ADL limitations (most recent use associated with highest ADL limitations).OT service use was measured through participant recall.
Finlayson, Shevil, & Cho (2009) Cross-sectional, descriptive studyn/aDataset same as Finlayson, Garcia, & Cho (2008) . N = 1,003; all provided permission to contact their caregivers. Individual caregivers were stratified according to age of participants they cared for who had MS (45–64 or ≥65), and participants were randomly selected to complete an interview.Inclusion: caregiver and participant dyadsAgreement between participants with MS and their caregivers on extent of cognitive symptoms was measured.Kappa and ICC to examine agreement; multi-nomial regression to examine characteristics61 % of participants with MS reported that cognitive symptoms interfered with activity engagement.Questions posed to caregivers and participants with MS about cognitive symptoms not worded identically and relied on self-report.
N = 279 participants with MS (mean age = 62.8, SD = 9.4), mean duration of disease = 18.3 years, SD = 11.8Characteristics of those participants with discrepancies in agreement with care-giver were examined.Fair agreement between caregiver and participants with MS (κ = .39)Gap in time between caregiver interview and participants was several months, during which time cognitive symptoms may have changed.
ICC = .2, (20% of total variation in responses can be attributed to within-pair discrepancies)
Discrepancies in agreement associated with greater disease duration (caregiver noted symptoms more often) and being female (participant noted symptoms more often)
Haak, Fange, Horstmann, & Iwarsson (2008) Secondary data analysis, descriptive study, validity studyn/aENABLE–AGE database of 5 European countries examining home environment and participation in very old people (N = 1,918). Involved baseline interview and follow-up period at 1-year interval (T1 and T2).Sample drawn at random from Swedish Central Population Register and stratified by age and gender.Examined relationship between the housing and neighborhood environments at T1 and two dimensions of participation at T2.Spearman rank correlation coefficientsAspects of housing and neighborhood environment more strongly related to performance-oriented participation and related less strongly to togetherness-oriented participation.1-year gap between environmental factors and participation outcomes may affect relationship.
Inclusion: people ≥ age 80 living alone in 3 Swedish municipalities with sufficient data at T1 and T2Performance oriented and togetherness orientedCriteria for determining sufficient evidence for validity on each dimension are unclear.
N = 314; at T1, median age = 85; 26% were male
median of 2 functional limitations
Yuen, Huang, Burik, & Smith (2008) Randomized controlled trialI5 LTC facilitiesInclusion: resident of LTC facility, ≥ age, spoke English as first language, able to converse for 1 hr, intelligible speech, MMSE score ≥ 19Intervention: Mentoring group—resident mentored an ESL student 2 times a week for 12 weeks with initial orientation by English language teachers.Multi-variate nonparametric global statistic to measure change scores from baseline to post-test and baseline to 3-month follow-upBoth groups had deteriorating well-being over the testing period, but the mentoring group had less deterioration that was statistically significant.Risk of attention bias because usual-care group did not control for attention.
Recruitment by authors meeting with facility staff and with residents of each facilityExclusion: uncorrectable hearing impairments, known maladaptive behavior patterns, psychotic symptoms, and illness with <6 months projected survivalUsual care: No intervention provided.Risk of attrition bias. There was a 28% attrition rate before postintervention data collection, and analysis included data of only participants who completed baseline and follow-up assessments.
ESL students recruited from 3 ESL schools.N = 39, randomized; final N = 28; mean age = 83.4, SD = 8.8; 71.4% female, mean months in LTC = 27.4Instruments used to measure main “well-being” outcomes:Not clear whether statistically significant results translate into clinical meaningful differences.
Geriatric Depression Scale, LSI–A, self-rated healthSmall sample limits generalizability.
Wood, Womack, & Hooper (2009) Case studyn/a2 Alzheimer’s special care units with different social and physical environments selected from centers identified by a local Area Agency on AgingInclusion: diagnosis of Alzheimer’s or neuro-degenerative dementia, ability to walk with or without assistance, ability to communicate needs, resided in SCU for ≥6 monthsActivity in Context and Time, computer-assisted tool to record environmental correlates of time use and affect of people with dementiaMean proportions of time spent in specific activities and affect states calculated.Daily time use and affect suggest that participants had capacities that were infrequently tapped in their activity experiences.Generalization of findings overall, site comparisons, and causal relationships limited because of case study design.
Exclusion: history of or current psychotic illnesses or major depressionStudy involved observation (12 hr per day for 4 days) of each participant by 1 of 4 observers. Codes representing dimensions of time use and affect and considered QoL indicators were recorded by observers.Correlations between specific activities and QoL indicatorsSome site differences found in engagement and affect at the traditional SCU compared with the homelike facility.
Participants at sites matched by age, gender, and functional status
N = 14; mean age = 81 at Site 1; mean age = 83 at Site 2
Mann et al. (2008) Secondary data analysis, longitudinal cohort studyn/aData were from Rehabilitation Engineering Research Center on Aging Consumer Assessments Study.Inclusion: ≥ age 60, lived in independent housing in the com- munity, and ≥ 16 on the CES-D at baselineDepressive symptoms: CES–DChanges between baseline and 3-year follow-up examined using Wilcoxon signed rank testsDepressive symptoms decreased over the 3-year period (25.7 at baseline to 22.3).Assistive devices were measured by self-report of participants and include items that may not have been obtained to compensate for declining abilities (e.g., TV remotes, cordless phones).
Data were collected from 1991 to 2001 to examine coping strategies of elders with disabilities.N = 73; mean age = 73.6, 81% female, 83.6% White, mean CES–D score = 25.7Impairment–disability status: OARS (vision–hearing impairment and IADL disability); MMSE; Sickness Impact Profile; FIM (disability)Predictors of changes in depression over the 3-year period examined by means of Kruskal–Wallis tests.Assistive device usage increased over time (from 11.9 at baseline to 17.9).Differences in inter-view administration by interviewers may have resulted in differing responses from participants.
N = 791 in datasetAssistive devices: assistive technology survey (use of and satisfaction with devices for physical disabilities; hearing, visual, or cognitive impairments)Predictors of CES-D change were number of illnesses, mental status, hearing impairment severity, number of days ill, QoL, and life satisfaction.Link to OT practice not clear.
Murphy, Smith, & Alexander (2008) Cohort studyn/aWomen with symptomatic knee or hip OA were recruited from fliers or a university subject registry in southeastern Michigan.Inclusion: age 55-80, ≥24 on MMSE, English-speaking, could operate actigraph device used in the study, X-ray evidence of OA in the knee or hip, and at least mild pain on the WOMAC pain scaleData collected using ecological momentary assessment over a 5-day period. Wrist-worn actigraph device beeped and participants recorded pain and fatigue, (severity [0–4] scales), activity pacing (frequency of use of pacing strategies on 0-4 scale), and physical activity (measured continuously by actigraph device [wrist-worn accelerometer]).t tests; hierarchical linear modelsHigh-activity pacers experienced significantly higher levels of morning fatigue and trends of higher morning pain, overall pain, and overall fatigue compared with low activity pacers.Further psychometric work on activity pacing scale needed.
Exclusion: nonambulatory, had other medical conditions that interfered with activities, or recent knee or hip joint replacementPhysical activity levels were lower for high activity pacers.Sample was small, primarily White, and well-educated, limiting generalizability.
N = 30; mean age = 63.8, SD = 6.9Activity pacing was independently associated with lower levels of physical activity.
Schmid & Rittman (2009) Qualitativen/aData obtained from ongoing longitudinal study to examine recovery patterns after stroke. All participants experienced an acute stroke, were discharged home, and continued to receive medical or rehabilitation.Inclusion: discussed poststroke falls without prompting during the 1-month or 6-month qualitative interviews; male; White, African-American, or Puerto Rican Hispanic; discharged directly home from an acute care unit; scored ≥18 on MMSE; able to communicate verbally at discharge; had a caregiver willing to participaten/an/aPrimary consequences of post-stroke falls were a limitation in activities or participation, increased dependence, and development of fear of falling.Generalizability not possible in qualitative studies.
N = 132 in datasetN = 42, mean age = 66.3, SD = 7.8Communication about falling was not collected systematically and was provided without prompting by par ticipants; therefore, the experience of falls may not be fully captured in this sample.
Table Footer NoteNote. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.
Note. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.×
Table 2.
Productive Aging Articles Published in AJOT in 2008–2009
Productive Aging Articles Published in AJOT in 2008–2009×
Author and YearResearch Methodology UsedLevel of EvidenceSample Selection MethodSample Characteristics and Inclusion–Exclusion CriteriaInstruments, Measures, and Interventions UsedStatistics UsedResultsStudy Limitations
Hunt & Arbesman (2008) SRISearch terms developed by project coordinator, author of each review, and advisory board. Medical librarian assisted in article search.Literature search: peer-reviewed literature between 1980 and 2004; searching done in online databasesVisual, cognitive, and motor interventions: Visual attention—Useful Field of View Test; oculomotor skills and eye–hand coordination—Dynavision; home exercise programn/aRemediation of visual, cognitive, or motor deficits improves skillsUnclear whether studies that focus on skill remediation are translatable to on-road performance. Effects could reflect learning because the training tool was often also used as the assessment measure.
Inclusion: studies with OT in intervention or within the scope of OT practice and included interventions to the person, including family involvement and role of passengersEducational interventions: driver education, self-awareness–regulation programs, driving simulatorsDriving education programs and effect-of-passengers studies had mixed results.SR limited by heterogeneity in study quality, including lack of randomization, no control groups, small sample size, self-reported outcomes.
19 articles (10 Level I, 6 Level II, 3 Level III)Effect of passengers; medical interventions: cataract surgery, cognition-enhancing drugsMedical interventions showed positive effects on balance, decreased crash rate, and driving performance.
Stav (2008) SRISame as Hunt & Arbesman (2008) Literature search: Same as Hunt & Arbesman (2008) Policy interventions:n/aMore stringent relicensure policies reduced traffic-related fatalities; in Finland, more stringent policies in licensing of older adults may be linked to increased fatalities in this age group using alternative transportation.More inclusive outcome measures needed in policy studies (beyond data on short-term fatalities that may not fully capture crash incidents).
Inclusion: studies with policy interventions related to licensure restrictions, relicensing criteria, and retesting community mobility interventions related to program effectiveness or program evaluationIncreased testing during license renewal (e.g., visual screening, on-road testing), scores on performance tests, restricted or conditional licensingOutcomes do not include effects on participation or quality of life, which are often of most interest for OT intervention.
7 articles (6 Level II, 1 Level III)Community interventions: Alternative transportation programResearch into community mobility is lacking.
Bohr (2008) SRISame as Hunt & Arbesman (2008) Literature search: peer-reviewed literature between 1999 and 2004Legibility and identification of road signs, lane markings, and walking pace at crosswalksn/aInfrastructure studies showed font type, reflective coating, and traffic sign position affect sign visibility and legibility. Age differences in reaction time, identification errors, and eye fixation found during testing. Differences between indoor and outdoor walking paces were found, suggesting the influence of outdoor environmental conditions.Many studies may not generalize to on-road conditions because they were simulated or performed under only clear and dry weather conditions.
Searching done in online databases primarily in human factors and engineering fields
Guidelines for infrastructure before 1999 taken from a Federal Highway Administration handbook
Inclusion: studies that investigated infrastructure modifications of the physical environment on driving ability, performance, or safety
8 articles (6 Level I, 2 Level III)
Arbesman & Pellerito (2008) SRISame as Hunt & Arbesman (2008) Literature search: same as Hunt & Arbesman (2008) Modifications included window tinting, wind-shield angle, reflectance, familiarity with instrument panel.n/aModifications such as window tinting have negative affects on older adults’ driving performance.Lack of randomization, limited applicability to real-world driving in some studies.
Inclusion: Studies that related to impact of automobile-related modification typesAdaptive equipment included ITS (e.g., in-vehicle navigation and visual enhancement systems).Adaptive equipment shows positive effects in performance and satisfaction in use of some ITS.Lack of studies found in the use of low-tech adaptive equipment (cushions, mirrors, grab bars) and crash safety that may be important for OT interventions
22 articles: 7 on modifications for visibility and adaptive equipment (4 Level I, 3 Level II); 15 on ITS (6 Level I, 7 Level II, 2 Level III)
Kay, Bundy, & Clemson (2009) Preliminary validity studyn/aProspective cohort study, recruitment from two driving rehabilitation centers in Sydney, New South Wales, AustraliaInclusion: having a neurological condition and a diagnosis known to be associated with impaired awareness, ≥ age 60, referred for a driving assessmentDriveAware QuestionnaireKappa to measure agreement of level of awareness in ability between off-road and on-road assessment of driving ability.Substantial agreement (κ = .69) exists between rating of awareness of driving ability before and after on-road assessment.Not clear how 60 participants were selected.
N = 60; 72% sample was male; 77% had either mild cognitive impairment or dementia, and others had stroke, Parkinson’s disease, or other diseases.Although therapists during the on-road assessment were initially blinded to the therapist who rated participants in the off-road assessment, blinding could be breeched by the driving evaluator, who had knowledge of the first therapist’s evaluation.
Different therapists conducted on-road assessments; inter-rater reliability between therapists was not reported.
Classen, Awadzi, & Mkanta (2008) Secondary data analysis, cohortn/aU.S. Dept of Transportation 2003 Fatality Analysis Reporting System, a national crash database that contains census data on all crashes on public roads that result in at least one fatality 30 days after the crashInclusion: ≥ age 65 and involved in at least one auto crash in 2003Used theoretical model (Precede Proceed Model of Health Promotion) to identify person, vehicle, and environmental factors related to driving performance.Log-linear modeling to measure two-way interactions among person, vehicle, and environment factorsPerson–environment interactions: Gender differences in when crashes occurredCross-sectional data limit causal inferences.
N = 5,744, 66.6% male, mean age = 75.96, SD = 7.11Vehicle–environment interactions: Crash type varied by time of dayCrashes in dataset were limited to those that involved a fatality. Less serious crashes would also be important to examine for older adults.
Finlayson, Garcia, & Cho (2008) Secondary data analysis, cross-sectional descriptive studyn/aDatabase constructed to examine aging in MS and unmet health-related service needs. It targeted people living in the midwestern United States.Inclusion: ≥ age 45 with a self-reported diagnosis of MSExamined factors associated with use of OT services.Proportional odds models62% of participants had never used OT services as part of their care.OT service patterns in small geographic region may not generalize.
N = 1,282; mean age = 63.8, SD = 9.4; 74% female, mean duration of disease = 20 years, SD = 11.4Most recent users of OT were those residing in an urban or suburban area and those who lived alone. Use of OT was associated with extent of ADL limitations (most recent use associated with highest ADL limitations).OT service use was measured through participant recall.
Finlayson, Shevil, & Cho (2009) Cross-sectional, descriptive studyn/aDataset same as Finlayson, Garcia, & Cho (2008) . N = 1,003; all provided permission to contact their caregivers. Individual caregivers were stratified according to age of participants they cared for who had MS (45–64 or ≥65), and participants were randomly selected to complete an interview.Inclusion: caregiver and participant dyadsAgreement between participants with MS and their caregivers on extent of cognitive symptoms was measured.Kappa and ICC to examine agreement; multi-nomial regression to examine characteristics61 % of participants with MS reported that cognitive symptoms interfered with activity engagement.Questions posed to caregivers and participants with MS about cognitive symptoms not worded identically and relied on self-report.
N = 279 participants with MS (mean age = 62.8, SD = 9.4), mean duration of disease = 18.3 years, SD = 11.8Characteristics of those participants with discrepancies in agreement with care-giver were examined.Fair agreement between caregiver and participants with MS (κ = .39)Gap in time between caregiver interview and participants was several months, during which time cognitive symptoms may have changed.
ICC = .2, (20% of total variation in responses can be attributed to within-pair discrepancies)
Discrepancies in agreement associated with greater disease duration (caregiver noted symptoms more often) and being female (participant noted symptoms more often)
Haak, Fange, Horstmann, & Iwarsson (2008) Secondary data analysis, descriptive study, validity studyn/aENABLE–AGE database of 5 European countries examining home environment and participation in very old people (N = 1,918). Involved baseline interview and follow-up period at 1-year interval (T1 and T2).Sample drawn at random from Swedish Central Population Register and stratified by age and gender.Examined relationship between the housing and neighborhood environments at T1 and two dimensions of participation at T2.Spearman rank correlation coefficientsAspects of housing and neighborhood environment more strongly related to performance-oriented participation and related less strongly to togetherness-oriented participation.1-year gap between environmental factors and participation outcomes may affect relationship.
Inclusion: people ≥ age 80 living alone in 3 Swedish municipalities with sufficient data at T1 and T2Performance oriented and togetherness orientedCriteria for determining sufficient evidence for validity on each dimension are unclear.
N = 314; at T1, median age = 85; 26% were male
median of 2 functional limitations
Yuen, Huang, Burik, & Smith (2008) Randomized controlled trialI5 LTC facilitiesInclusion: resident of LTC facility, ≥ age, spoke English as first language, able to converse for 1 hr, intelligible speech, MMSE score ≥ 19Intervention: Mentoring group—resident mentored an ESL student 2 times a week for 12 weeks with initial orientation by English language teachers.Multi-variate nonparametric global statistic to measure change scores from baseline to post-test and baseline to 3-month follow-upBoth groups had deteriorating well-being over the testing period, but the mentoring group had less deterioration that was statistically significant.Risk of attention bias because usual-care group did not control for attention.
Recruitment by authors meeting with facility staff and with residents of each facilityExclusion: uncorrectable hearing impairments, known maladaptive behavior patterns, psychotic symptoms, and illness with <6 months projected survivalUsual care: No intervention provided.Risk of attrition bias. There was a 28% attrition rate before postintervention data collection, and analysis included data of only participants who completed baseline and follow-up assessments.
ESL students recruited from 3 ESL schools.N = 39, randomized; final N = 28; mean age = 83.4, SD = 8.8; 71.4% female, mean months in LTC = 27.4Instruments used to measure main “well-being” outcomes:Not clear whether statistically significant results translate into clinical meaningful differences.
Geriatric Depression Scale, LSI–A, self-rated healthSmall sample limits generalizability.
Wood, Womack, & Hooper (2009) Case studyn/a2 Alzheimer’s special care units with different social and physical environments selected from centers identified by a local Area Agency on AgingInclusion: diagnosis of Alzheimer’s or neuro-degenerative dementia, ability to walk with or without assistance, ability to communicate needs, resided in SCU for ≥6 monthsActivity in Context and Time, computer-assisted tool to record environmental correlates of time use and affect of people with dementiaMean proportions of time spent in specific activities and affect states calculated.Daily time use and affect suggest that participants had capacities that were infrequently tapped in their activity experiences.Generalization of findings overall, site comparisons, and causal relationships limited because of case study design.
Exclusion: history of or current psychotic illnesses or major depressionStudy involved observation (12 hr per day for 4 days) of each participant by 1 of 4 observers. Codes representing dimensions of time use and affect and considered QoL indicators were recorded by observers.Correlations between specific activities and QoL indicatorsSome site differences found in engagement and affect at the traditional SCU compared with the homelike facility.
Participants at sites matched by age, gender, and functional status
N = 14; mean age = 81 at Site 1; mean age = 83 at Site 2
Mann et al. (2008) Secondary data analysis, longitudinal cohort studyn/aData were from Rehabilitation Engineering Research Center on Aging Consumer Assessments Study.Inclusion: ≥ age 60, lived in independent housing in the com- munity, and ≥ 16 on the CES-D at baselineDepressive symptoms: CES–DChanges between baseline and 3-year follow-up examined using Wilcoxon signed rank testsDepressive symptoms decreased over the 3-year period (25.7 at baseline to 22.3).Assistive devices were measured by self-report of participants and include items that may not have been obtained to compensate for declining abilities (e.g., TV remotes, cordless phones).
Data were collected from 1991 to 2001 to examine coping strategies of elders with disabilities.N = 73; mean age = 73.6, 81% female, 83.6% White, mean CES–D score = 25.7Impairment–disability status: OARS (vision–hearing impairment and IADL disability); MMSE; Sickness Impact Profile; FIM (disability)Predictors of changes in depression over the 3-year period examined by means of Kruskal–Wallis tests.Assistive device usage increased over time (from 11.9 at baseline to 17.9).Differences in inter-view administration by interviewers may have resulted in differing responses from participants.
N = 791 in datasetAssistive devices: assistive technology survey (use of and satisfaction with devices for physical disabilities; hearing, visual, or cognitive impairments)Predictors of CES-D change were number of illnesses, mental status, hearing impairment severity, number of days ill, QoL, and life satisfaction.Link to OT practice not clear.
Murphy, Smith, & Alexander (2008) Cohort studyn/aWomen with symptomatic knee or hip OA were recruited from fliers or a university subject registry in southeastern Michigan.Inclusion: age 55-80, ≥24 on MMSE, English-speaking, could operate actigraph device used in the study, X-ray evidence of OA in the knee or hip, and at least mild pain on the WOMAC pain scaleData collected using ecological momentary assessment over a 5-day period. Wrist-worn actigraph device beeped and participants recorded pain and fatigue, (severity [0–4] scales), activity pacing (frequency of use of pacing strategies on 0-4 scale), and physical activity (measured continuously by actigraph device [wrist-worn accelerometer]).t tests; hierarchical linear modelsHigh-activity pacers experienced significantly higher levels of morning fatigue and trends of higher morning pain, overall pain, and overall fatigue compared with low activity pacers.Further psychometric work on activity pacing scale needed.
Exclusion: nonambulatory, had other medical conditions that interfered with activities, or recent knee or hip joint replacementPhysical activity levels were lower for high activity pacers.Sample was small, primarily White, and well-educated, limiting generalizability.
N = 30; mean age = 63.8, SD = 6.9Activity pacing was independently associated with lower levels of physical activity.
Schmid & Rittman (2009) Qualitativen/aData obtained from ongoing longitudinal study to examine recovery patterns after stroke. All participants experienced an acute stroke, were discharged home, and continued to receive medical or rehabilitation.Inclusion: discussed poststroke falls without prompting during the 1-month or 6-month qualitative interviews; male; White, African-American, or Puerto Rican Hispanic; discharged directly home from an acute care unit; scored ≥18 on MMSE; able to communicate verbally at discharge; had a caregiver willing to participaten/an/aPrimary consequences of post-stroke falls were a limitation in activities or participation, increased dependence, and development of fear of falling.Generalizability not possible in qualitative studies.
N = 132 in datasetN = 42, mean age = 66.3, SD = 7.8Communication about falling was not collected systematically and was provided without prompting by par ticipants; therefore, the experience of falls may not be fully captured in this sample.
Table Footer NoteNote. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.
Note. OT = occupational therapy; n/a = not applicable; SR = systematic review; ITS = intelligent transportation systems; SD = standard deviation; MS = multiple sclerosis; ADL = activity of daily living; ICC = intraclass correlation coefficient; T1 = Time 1; T2 = Time 2; LTC = long-term care; ESL = English as a second language; MMSE = Mini-Mental State Examination; LSI–A = Life Satisfaction Index–A; SCU = special care unit; QoL = quality of life; CES–D = Center for Epidemiologic Studies Depression Scale; OARS = Older Americans Resources and Services Program; IADL = instrumental activity of daily living; OA = osteoarthritis; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.×
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